Bethge Matthias
Institute of Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany.
Scand J Work Environ Health. 2016 Jul 1;42(4):273-9. doi: 10.5271/sjweh.3562. Epub 2016 Apr 13.
Graded work exposure is deemed to have a therapeutic effect. In Germany, graded return-to-work (GRTW) is therefore frequently used following a rehabilitation program if workers are still unable to perform full job duties. The aim of the analyses was to determine long-term effects on disability pension and regular employment.
Analyses were performed with longitudinal administrative data. Patients aged 18-60 years who attended an orthopedic, cardiac, oncological, or psychosomatic rehabilitation between January and June 2007 were eligible to participate in a GRTW scheme. The effects of GRTW were analyzed by a propensity-score-matched comparison of patients with and without GRTW. Outcomes were disability pension rates, regular income, and the duration of receiving welfare benefits due to sickness absence and unemployment up to the end of 2009.
The propensity-score-matched sample comprised 1875 patients on GRTW and 1875 matched controls not undergoing GRTW. The probability of a disability pension was decreased by about 40% among GRTW patients [5.4% versus 8.6%; hazard rate ratio (HR) 0.62, 95% confidence interval (95% CI) 0.49-0.80]. The three-year income (2007-2009) was EUR12 920 higher (95% CI EUR10 054-15 786) in the GRTW group. The duration of receiving welfare benefits due to sickness absence and unemployment was significantly reduced.
Graded work exposure supports labor participation and reduces the risk of permanent work disability.
分级工作接触被认为具有治疗效果。因此，在德国，如果工人仍无法履行全部工作职责，康复计划后经常采用分级返岗（GRTW）。分析的目的是确定对残疾抚恤金和正常就业的长期影响。
使用纵向行政数据进行分析。2007年1月至6月期间参加骨科、心脏科、肿瘤科或身心康复的18至60岁患者有资格参加GRTW计划。通过倾向得分匹配比较接受和未接受GRTW的患者来分析GRTW的效果。结果包括残疾抚恤金率、正常收入以及截至2009年底因病假和失业领取福利金的持续时间。
倾向得分匹配样本包括1875名接受GRTW的患者和1875名未接受GRTW的匹配对照。接受GRTW的患者中领取残疾抚恤金的概率降低了约40%[5.4%对8.6%；风险率比（HR）0.62，95%置信区间（95%CI）0.49 - 0.80]。GRTW组的三年收入（2007 - 2009年）高出12920欧元（95%CI为10054 - 15786欧元）。因病假和失业领取福利金的持续时间显著缩短。
分级工作接触有助于劳动力参与并降低永久性工作残疾的风险。
